title: An adverse event trigger tool in dentistry: a new methodology for measuring harm in the dental office.
abstract: BACKGROUND
  There is a dearth of knowledge about the type and frequency of adverse events (AEs) in dentistry. Current approaches to obtaining information rely on reviews of randomly selected records, which may not be the most efficient or effective methodology.
  
  
  METHODS
  Inspired by the Institute for Healthcare Improvement's (IHI) global and outpatient trigger tools, which identifies records with characteristics ("triggers") that are associated with AEs, the authors created the dental clinic trigger tool. The triggers included procedures for incision and drainage, failed implants and selected treatment patterns. The authors ran the trigger tool against six months of electronic health records data and compared its performance with that of a review of 50 randomly selected patient records.
  
  
  RESULTS
  In total, 315 records were triggered, 158 (50 percent) of which were positive for one or more AEs; 17 (34 percent) of the 50 randomly selected records were positive for at least one AE. The authors assigned each AE an IHI severity ranking. Most AEs caused temporary harm, but nine were considered to have caused permanent harm according to a modified IHI severity ranking.
  
  
  CONCLUSIONS
  The study results demonstrate the promise of a directed records review approach, as the dental clinic trigger tool was more effective in identifying AEs than was a review of randomly selected records.
  
  
  CONCLUSIONS
  All dental practices should proactively monitor the safety of the care they provide. Use of the trigger tool will help make this process more efficient and effective.
authors.affiliation: Office of Clinical Affairs, Harvard School of Dental Medicine, Boston, Mass. 02115, USA. Elsbeth_kalenderian@hsdm.harvard.edu
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Kalenderian
authors.forename: Muhammad F
authors.initials: MF
authors.lastname: Walji
authors.forename: Anamaria
authors.initials: A
authors.lastname: Tavares
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Ramoni
mesh_terms: D003729:Dental Care / Q000706:statistics & numerical data; D003770:Dental Offices; D003792:Dental Records; D004322:Drainage; D057286:Electronic Health Records; D006801:Humans; D007049:Iatrogenic Disease; D007249:Inflammation; D019300:Medical Errors / Q000517:prevention & control; D062072:Patient Acuity; D064406:Patient Harm / Q000517:prevention & control; D061214:Patient Safety; D011237:Predictive Value of Tests; D017751:Safety Management / Q000379:methods*; D009626:Terminology as Topic; D017211:Treatment Failure
keywords: Patient safety; adverse event; dentistry; electronic health record; trigger tool